Burch colposuspension, pubovaginal sling, and midurethral retropubic tape (RT) and
transobturator tape (TOT) have been the most popular surgical treatments for female
stress urinary incontinence (SUI). Several randomized controlled trials (RCTs) have
been published comparing the different techniques, with conflicting results.
Our aim was to evaluate the efficacy, complication, and reoperation rates of midurethral
tapes compared with other surgical treatments for female SUI.
A systematic review of the literature was performed using the Medline, Embase, Scopus,
Web of Science databases, and Cochrane Database of Systematic Reviews.
Thirty-nine RCTs were identified. Patients receiving midurethral tapes had significantly
higher overall (odds ratio [OR]: 0.61; confidence interval [CI]: 0.46-0.82; p=0.00009)
and objective (OR: 0.38; CI: 0.25-0.57; p<0.0001) cure rates than those receiving
Burch colposuspension, although they had a higher risk of bladder perforations (OR:
4.94; CI: 2.09-11.68; p=0.00003). Patients undergoing midurethral tapes and pubovaginal
slings had similar cure rates, although the latter were slightly more likely to experience
storage lower urinary tract symptoms (LUTS) (OR: 0.31; CI: 0.10-0.94; p=0.04) and
had a higher reoperation rate (OR: 0.31; CI: 0.12-0.82; p=0.02). Patients treated
with RT had slightly higher objective cure rates (OR: 0.8;CI: 0.65-0.99; p=0.04) than
those treated with TOT; however, subjective cure rates were similar, and patients
treated with TOT had a much lower risk of bladder and vaginal perforations (OR: 2.5;
CI: 1.75-3.57; p<0.00001), hematoma (OR: 2.62; CI: 1.35-5.08; p=0.005), and storage
LUTS (OR: 1.35; CI: 1.05-1.72; p=0.02). Meta-analysis demonstrated similar outcomes
for TVT-O (University of Liège, Liège, Wallonia, Belgium) and Monarc (AMS, Minnetonka,
Patients treated with RT experienced slightly higher continence rates than those treated
with Burch colposuspension, but they faced a much higher risk of intraoperative complications.
RT and pubovaginal slings were similarly effective, although patients with pubovaginal
slings were more likely to experience storage LUTS. The use of RT was followed by
objective cure rates slightly higher than TOT, but subjective cure rates were similar.
TOT had a lower risk of bladder and vaginal perforations and storage LUTS than RT.
The strength of these findings is limited by the heterogeneity of the outcome measures
and the short length of follow-up.
Copyright (c) 2010 European Association of Urology. Published by Elsevier B.V. All